* Дослідження виконано в межах наукової тематики Харківської медичної академії післядипломної освіти МОЗ України «Порушення здоров'я сім'ї у кризових станах різного ґенезу. Причини, механізми розвитку, клінічні прояви і система психодіагностики, психокорекції, психопрофілактики» (номер державної реєстрації 0112U000972) та «Медико-психологічні наслідки соціального стресу та інформаційно-психологічної війни (макро-, мікросоціальні чинники дезадаптації, механізми формування, система психодіагностики, психокорекції, психопрофілактики)» (номер державної реєстрації 0117U000371). Установою, що фінансує дослідження, є МОЗ України. Автори гарантують повну відповідальність за все, що опубліковано в статті. Автори гарантують відсутність конфлікту інтересів і власної фінансової зацікавленості при виконанні роботи та написанні статті. Рукопис надійшов до редакції 25.03.2019.
Today remains understudied health issue – the psychological aspect of the problem of acute therapeutic diseses. Among the most common diseases – coronary heart disease (CHD), myocardial infarction (MI), crisis states in patients with arterial hypertension (AH), transient ischemic attack (TIA) and acute stroke (AS), gastric ulcer and duodenal ulcer (GUDU). Question clinical features of the structure, dynamics, current and immediate link with the medical condition is not fully understood, which was the basis of our research, the purpose of which was to identify psychic disturbances in patients with acute therapeutic disease. 187 patients were examined, 34 CHD patients, 37 – MI, 38 – TIA, 39 – AH, 39 – GUDU. 65% male and 35% female aged 20 to 60 years. The main research method was clinical and psychopathological. A high-level affective and neurotic disorders in these patients was observed. Structured analysis allowed identifying four main options disturbances: nosogenic neurotic reaction–68 patients; somatogenic asthenic syndrome – 46 patients; reaction psychological maladjustment – 34 patients; acute stress reactions–39 patients. Stratification of structure psychopathological syndroms allowed systematizing them in 4 different manifestations: asthenic–24%; anxiety-46%; subdepressive-11%; somatoform-19%. This was the basis for the determination early psychotherapeutic correction program, formed by integrative model. The high efficacy was shown in 74% patients, middle range – in 15%, low-in 11% patients.
The result of the development of research in cardiology revealed the opportunity to implement the concept of the “golden hour” to restore coronary blood flow, which formed a new attitude to myocardial infarction with the recognition of its emergency, treatment of which requires emergency hospitalization. In recent years, a sufficient number of multicenter studies have been conducted, the data of which provided an opportunity to formulate the main strategic directions of care for patients with acute coronary syndrome and became the basis for the development of clinical guidelines by leading national and international organizations. The aim of our research was to conduct a comparative analysis of modern approaches to the treatment of acute coronary syndrome in Ukraine and abroad. The research used logical, graphical methods and the method of system analysis. The article covers modern issues of classification of acute coronary syndrome, methods of its diagnosis and treatment. Based on the results of clinical studies, global trends in the diagnosis and treatment of acute coronary syndrome are shown. The article also discusses the organization of medical care, and in particular the possibilities and problems of reperfusion therapy in the treatment of acute coronary syndrome. Analysis of literature sources and own data indicate the existence of some problems in the treatment of acute coronary syndrome, among which significant factors in high mortality are late treatment and late hospitalization. Organizational measures to improve patient awareness, early diagnosis, and early reperfusion treatment are important steps in improving the prognosis of acute coronary syndrome.
Based on the systematic approach of evaluating results of complex clinical- psychopathological, psychodiagnostical investigation cardiac infarction and cerebral stroke patients the clinical structure features, regularities in the formation, development and course of òonpsychotic psychic disorders on these patients was determined.At patients with cardial infarction in acute period the painful syndrome was the main one, leads to severe psycho-emotional disturbances. At the background of preservation of cognitive function phobic, anxiety and depressive symptoms were prevaileted, the severity of which depends on the severity of pain. Subsequently, the primary psycho-emotional component disappeared, anxiety-depressive disorders, hypo-and anozognostical type of perception of self condition were formed.At cerebral stroke patients disorders of level of consciousness were primary with cognitive and asthenic disturbances with subsequent formation of psycho-emotional disorders, anxiety and depressive disorders with hypohondrical elements on the basis of persistent cognitive impairments.The multimodal principle based system of psychotherapeutical correction of nonpsychotic psychic disorders was developed. For myocardial infarction patients, system includes personaly - oriented, rational, and autogenic-training therapy for cerebral stroke patients - hypnosuggestive, cognitive - behavioral therapy, cognitive and autogenic-training therapy. The proposed system showed a significant improvement in 80% of myocardial infarction patients and 77% of patients cerebral stroke, a partial improvement - 10% of myocardial infarction patients and 13% of cerebral stroke patients.
Contemporary remains understudied health issue - the psychological aspect of the acute therapeutic diseases problem. Among the most common diseases - coronary heart disease (CHD), myocardial infarction (MI), crisis states in patients with arterial hypertension (AH), transient ischemic attack (TIA) and acute stroke (AS), gastric ulcer and duodenal ulcer (GU&DU). Clinical features of the structure, dynamics, current and immediate link with the medical conditions is not fully understood. The basis of our research, the purpose of which, was to identify mental disturbances in patients with acute therapeutic diseases. One hundred and eighty-seven patients were examined, 34 CHD patients, 37–MI, 38 - TIA, 39–AH, 39 - GU&DU, 65% male and 35% female aged 20 to 60 years. The main research method was clinical and psychopathological. A high-level affective and neurotic disorders in these patients was observed. Structured analysis allowed identifying four main options disturbances: nosogenic neurotic reaction–68 patients; somatogenic asthenic syndrome–46 patients; reaction psychological maladjustment–34 patients; acute stress reactions–39 patients. Stratification of structure psychopathological syndroms allowed systematizing them in 4 different groups: asthenic–24%; anxiety - 46%; subdepressive - 11%; somatoform - 19%. That was the basis for the determination early psychotherapeutic correction program, formed by integrative model. The high efficacy was shown in 74% patients, middle range–in 15%, low–in 11% patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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